Skeletal age at onset is most important factor in determining prognosis. Adult OCD lesions have very limited capacity to heal and are typically progessive. Juvenile OCD lesions with an intact articular surface have a potential for healing with cessation of repetitive impact loading activities.

A/P, notch, and lateral views of both knees. Bilateral films indicated because of high incidence of bilateral disease. Some lesions are only visible on notch views (knee flexed 30-50 degrees). Typically appear as well circumsribed area of sclerotic subchondral bone separated fromthe remainder of the epiphysis by a radiolucent line.

MRI: fragment instability indicated by: an area of increased homogenous signal 5 mm in diameter beneath the lesion; a focal defect 5 mm in the articular surface; and a high signal line traversing the subchondral plate into the lesion. (De Smet AA, Skeletal Radiol 1997; 26: 463)

Bone scan may be helpful in determining prognosis. (Paletta GA Jr,ALSM 1998; 26: 7) Indicated for juvenile patients with stable lesions on xray and MRI. If the lesion is positive on bone scan, non-operative treatment is indicated.

OCD Classification / Treatment

Lesions are generally classified radiographically by location, size, stability and skeletal age of patient.

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